Unfortunately, in spite of the development of antibiotics and diligent work on the part of physicians, ears occasionally become infected beyond the point where medicines will be of any further help to them. When these situations arise, the patients need a surgical procedure to help correct the infection, known as a mastoidectomy.
The mastoid is a honeycomb cavity in the bone, which lies directly behind the ear and is connected to the middle ear space (which lies between the eardrum and the inner ear). When a hole arises in the eardrum due to previous injury or infection or when a longstanding infection persists in the middle ear or mastoid, mastoid surgery often becomes necessary to alleviate this infection. Some patients also develop an abnormal growth of skin within the middle ear and mastoid cavity, known as a cholesteatoma. Cholesteatomas are dangerous for several reasons: 1. They serve as a focal point for recurrent infections, 2. They secrete enzymes that cause destruction of surrounding tissues, 3. They can potentially lead to more serious problems, including meningitis, facial paralysis, and stroke. Mastoid surgery removes the cholesteatoma from the mastoid cavity and middle ear space. In an effort to ensure ultimate success of mastoidectomy, the opening to the ear canal may have to be enlarged.
Frequently the hearing is not improved by mastoidectomy, and occasionally it's even made worse. Hearing preservation is not the primary object behind mastoid surgery but rather the number one goal is to get rid of the infection and/or cholesteatoma, which is of potential danger to the patient. Mastoid surgery, when done in the proper setting, is successful in attaining this goal in approximately 9 out of 10 patients.
The procedure for mastoidectomy takes place under general anesthesia and takes approximately two to three hours. This is done either by itself or in conjunction with other procedures including tympanoplasty and ossicular chain reconstruction. An incision is made just behind the ear. This incision is typically very well masked within an existing skin crease, and the resulting scar usually heals to the point of being imperceptible to the naked eye. A surgical drill is then used to open up the air cells of the mastoid cavity, taking care to preserve the important surrounding structures, including the facial nerve, the ossicles of the middle ear, and the balance and hearing organs of the inner ear. Diseased mastoid lining and cholesteatoma is then carefully removed from the mastoid cavity. The incision behind the ear is then sutured closed. Occasionally the opening of the ear canal is enlarged during surgery to allow for proper post-operative care of the ear.
After spending several hours in the recovery area, you will be discharged home. Pain associated with the procedure is typically mild, and is resolved by taking the prescribed pain medications. You will remove the ear cup dressing the next morning. Do not be concerned regarding your hearing during the healing process. It takes 6 - 8 weeks before we can evaluate improvement and your hearing will be tested at that time. Bloody drainage from the incision area may occur during the first 1-2 days. Call the office if this persists longer than 2 days or if the incision site develops an odor, swelling, or pain. Water should be kept out of the ear until it is healed. You may take a shower 4 days after the surgery provided you cover the ear canal opening with a cotton plug soaked in ointment. Do not blow your nose for 4 weeks. If you sneeze, do so with your mouth open. Ear drops should be used as prescribed. No bending, lifting, straining aerobic exercise, heavy work or traveling until approved by your surgeon. DO NOT USE ASPIRIN OR IBUPROFEN PRODUCTS FOR 2 WEEKS BEFORE AND 1 WEEK AFTER SURGERY. No flying or changes in altitude until cleared by your surgeon.
Risks of Surgery
There are risks associated with mastoid surgery due to the close relationship between the disease process and structures within the middle ear and mastoid bone itself. In almost all cases there is some alteration in taste on the side of the tongue involved in mastoid surgery. This is because the nerve, which is responsible for taste on that side of the tongue, is generally involved in the disease process and must be removed with the disease. You may notice some unsteadiness following the surgery. In rare cases it is a permanent condition. It is also possible, although quite uncommon, that ear infection may follow the surgery resulting in a residual hole in the new eardrum. This generally can be patched by a second operation and is of little long-term consequence. The facial nerve, which goes to the muscles on the side of the face, crosses through the middle ear and mastoid and is often involved in the mastoid infection. On extremely rare occasions (less than 1 in 1000 patients), this nerve may be injured in an effort to remove all of the disease process resulting in weakness on that side of the face. When this does occur, the weakness is almost always temporary, but some long-term weakness may result.